Background to reform process

Reforming the NHS Complaints Procedure: a listening document was published at the same time as a National Evaluation Report on the NHS Complaints Procedure in September 2001.

Relevant documents (external link)

Key issues identified by the evaluation study

• there is a strong perception that the procedure itself is not sufficiently independent from those being complained about, with particular concern about whether the Independent Review stage is sufficiently independent
• many complainants felt dissatisfied with
  • their experience of the complaints procedure
  • the length of time it took to deal with their complaint, both at local resolution and for independent review
• staff operating the procedure agreed with this
• both complainants and staff felt that there was no systematic way of ensuring that
  • lessons were learned from their experiences of services, and of the complaints procedure
  • for making improvements to service provision as a result.

Feedback from the listening exercise also identified key areas to focus on

• improved accessibility and making it easier to complain
• monitoring and accountability
• guidance and support
• time scales for dealing with complaints
• mediation and conciliation
• scope for patients to complain direct to Primary Care Trusts in relation to family health service practitioners
• scope to bring certain complaints to the attention of the Ombudsman more quickly.

The listening document asked for the views of patients, the public and staff on the proposals suggested to improve the process.

Feedback from the listening exercise reinforced the need to

• see complaints as a chance for getting feedback on why things go wrong and how they can be improved
• get local resolution right as this could, and should be the best solution for all involved
• reform independent review to make it fair and unbiased
• invest in training for staff so they can confidApril 24, 2007 staff and resources for the system to be supportive, effective and time-efficient
• harmonise NHS and social services complaints systems.

The Department of Health launched a formal consultation on the draft regulatory framework.

The Department of Health published, in April 2003, "NHS complaints reform - making things right"(external link), which described its proposals to reform the NHS complaints procedure. It set out a programme to improve management of the whole complaints system and introduced operational improvements focused around

• making the system more flexible so that there are a range of ways in which people can express concerns about the services they have received
• improving local resolution so that formal complaints are more likely to be resolved at this stage, reducing the need for them to escalate unnecessarily
• radical reform to the independent review stage, subject to primary legislation - by placing responsibility for it with the Healthcare Commission
• making sure information about complaints and their causes are an integral part of the system that assures safe, high quality care, which is constantly improving

The Department of Health’s vision for a successful complaints procedure is of one which meets the needs of patients and staff by making the process

• open and easy to access – by being flexible about the ways in which people can complain and providing effective support for people wishing to do so
• fair and independent – with the emphasis on early and effective resolution so minimizing the strain and distress for all those involved
• responsive – providing appropriate and proportionate responses and redress
• learning and developing – ensuring complaints are viewed as a positive opportunity to listen and learn from patients views to drive continual improvement in services.

At the heart of the programme for reform is changing attitudes to complaints so they are integral to clinical governance and service improvement. Local resolution seeks to provide prompt investigation and resolution of the complaint at local level, aiming to satisfy the complainant whilst being fair to staff. The initial response to someone who feels aggrieved is often crucial in establishing the confidence that their grievance will be properly treated. By responding quickly and efficiently, there will be a better chance of early resolution.

Key changes in the reform process
The 2006 amended regulations introduced a number of key changes that are designed to make the procedure more accessible, responsive, independent and more closely linked to systems for improving services. They were introduced after the Department of Health had been able to give proper consideration to recommendations made by the Shipman Inquiry (as well as other inquiries – Ayling, Neale, Kerr & Haslam). In the light of the  Shipman Inquiry, which made recommendations for fundamental changes to the way complaints are handled, the Department will shortly be issuing a consultation paper with proposals for a new complaints system. This is referred to in: “Safeguarding Patients” (external link) (February 2007)

Next: The Commission for Social Care Inspection (CSCI)